RALPH CHRISTY: Good afternoon, ladies and gentlemen. I'm Ralph Christy, director of CIIFAD, and I'm absolutely delighted to welcome you all to our spring CIIFAD seminar series. We have-- and I literally mean we-- have been working ever since almost the beginning of the fall to put this series together. And along with my partners in crime, Laura Kramer, principally, Professor Peter Hobbs and Professor Louise Buck.
We have assembled, I think, an exciting set of speakers who will come to this hour each week to discuss perspectives in international development. As you will notice in the series, we have made a real effort to reach across the university campus, involving 10 different departments, a wide variety of subjects and topics, and also we have extended offering of the one credit to one additional department, the applied economics and management department, making a total of four different departments where students will come on a weekly basis and join in with us on this conversation.
I guess it gives a real challenge for us to define the concept of development because we see it embedded in 10 different departments. But the conversation nevertheless will go on. I think it speaks to the multifaceted nature of the concept of development to really show that Cornell is indeed a place where development is taken quite seriously.
To kick off this spring series, I am very pleased to introduce a person that really needs no introduction on our campus, as she came here several years ago, was chair of the Department of Education, has done research in adult education, indigenous knowledge, development of educational programs, and has been a real leader in the area of international development programs here on our campus.
She has a wonderful journey, indeed, a story, to talk to us about today. So with no further ado, I am delighted to introduce Professor Rosemary Caffarella to provide our first seminar for the semester. Thank you all very much.
SPEAKER: Thank you.
ROSEMARY CAFFARELLA: First, thank you all for coming. And very much, as Professor Christy just said, this is going to be a journey from-- actually, it's going to be a quick two different parts. It's going to be a quick overview of a seven-year journey. And I want to emphasize the seven years, and you'll see why later, of a breast cancer education project in Malaysia that came about because of happenstance.
And the other piece of this is how out of this project we have been developing a model related to thinking about the factors and the actual components of what, if you took a look at a sustainable program or were looking to make a sustainable program, what would you need. And so that's kind of where we'll end up.
An idea is born, and it literally was born. That's me, and this is Professor Maznah Mohamad And we're both breast cancer survivors across international lines, of course. When she was diagnosed, she called-- which is not unusual, because literally, there was no information in Bahasa, which is the language, the major language of Malaysia about anything about breast cancer. It was totally hidden.
And so what happened was I spent a lot of time on the phone with her. I spent time with oncology nurses on the phone here, with my own oncologist, who was wonderful in terms of the time he gave. And this is how this came about in terms of a need.
I sent her materials from the American Cancer Society. And the typical wait when you're in for chemotherapy treatments, when you're in for radiation or anything in a hospital or to see a doctor is three to five hours in a waiting room. And these are in some of the best hospitals in Malaysia.
So basically, she would bring these materials to these meetings and pass them around to the women, some who could read English well and some who could not. Because the reading level of the American Cancer Society materials is quite high, though they're moving more to some low literacy kinds of materials.
And so either she would translate them-- because what was happening is women coming into treatment had no idea what they were getting themselves in for. Surgery which was rather self-explanatory for most people. Chemotherapy was a foreign idea. There was no support groups except for one that I'm aware of, and that was for the Chinese community. And there was just no information.
So what happened was once Maznah went through her cancer treatment successfully-- and I'm happy to say she is now a seven-year survivor, which is really a miracle, because that's unusual in Malaysia, to put it mildly. The survival rate for breast cancer is, we estimate-- and we only have estimations because our database is very poor in Malaysia-- is one out of four. So it's very, very high in comparison, especially to the Western world.
And she went to the University of Georgia, and that's where she went on sabbatical. And so we went from there, our next step of our journey was to go to the American Cancer Society and ask them if we, in fact, could take their materials and do culturally sensitive and language appropriate translations.
Notice I said culturally sensitive and language appropriate. And I on purpose basically emphasize those words. It took me seven months to negotiate a contract with the American Cancer Society with the Cornell lawyers and their lawyers because there was this basic sense of can they really do that without losing the meaning and without screwing it up, basically. Though they didn't ever say that. That was my reading of it.
And finally, we were able to get a contract that would work. It was more work for the Malaysians, but it would work. So that's how this all started.
And right from the beginning-- and you can see in this first statement, those of you who are in my age group, who aren't many in the room, but there's a few-- that I came out of a community development background. So my bachelor's degree is in community development. I came out in the days of Saul Alinsky. And what we were interested in was building a sustainable breast cancer education for and by Malaysians. That was our goal from the beginning.
So it wasn't for us to bring in a program from the United States. Just from my time before in Malaysia, I had been there before. I knew Maznah well. That I knew that the programs that we have here would not look the same there. The cultural differences are too great.
So what we were exactly building, we didn't have a clue. And those of you who were here last semester, there were a number of people who talked about going into communities with some ideas and finding that what their original grant was written about, for example, in one case, water, couldn't actually deal with that subject until they dealt with other basic needs of the people.
And so they actually spent six or eight months building relationships, responding to some of those basic needs, and then moving into the water problem. So it's really trying to find out-- and we were on a journey. And that's the best way I can describe it. And I was really on a journey. I do not speak Bahasa.
I have learned an enormous amount on the journey. But our initial focus that we knew, and that was to do culturally sensitive and language appropriate translations. And this is an official project between-- because we have an MOU, between the Universiti Putra Malaysia, where Maznah a faculty member, and Cornell.
And we share the directorship. We're co-directors. Though part of my job this year on sabbatical is basically to turn the leadership over to the Malaysians. They're definitely ready. And they were actually ready before this, but we just didn't get to that point yet.
Malaysia. A winding journey is the best way I can describe what we went through because there was all kinds of twists and turns and roads that didn't go where we thought we were going to go. Those of you who are not familiar with Malaysia, this is Singapore, which was once a part of Malaysia. And basically-- I forgot I have a pointer. I don't want to go in front.
And so that's a very, very wealthy piece of a different country. And Kuala Lumpur is the capital. You'll notice those are the only two very large cities within that peninsula. Even the ones like Kota Bharu, like Kuantan, like Georgetown, Penang. They are cities, but they're very, very small cities. They have resources but not as many resources as you would find in KL, Kuala Lumpur.
Also, this area of the country-- I think the American Ambassador said it best when he said, Kuala Lumpur is not Malaysia. So if you stay in the Kuala Lumpur area, you're really not there. Which was a pretty strong message for someone who was doing a lot of wandering around, to say the least.
There's also a second part of Malaysia, which is Island Malaysia. And these two states are very, very different. And again, what's interesting about it is that there's many indigenous people here and also this is Indonesia. You'll notice Indonesia is on both sides. But this is the part that if you could get through the jungle, that has been at pretty much constant war and conflict.
So it kind of sits there. It's a multicultural nation, and they're talking about building roads, and I think Malaysia would prefer that they didn't built the roads, to be honest, to come through if they could. And there's also interesting-- with the Thai border because when the English drew the line, this part of Thailand is actually Malay, but they drew it at the river, which is not unusual.
And so you have even a warring factor at this part of Malaysia, up here in Thailand. And actually, Maznah, her family burial grounds are just-- it's right over in here. And she hasn't been able to go to Thailand. You don't cross the border there. And Penang, which is one of the universities we work with, USM, the only way to get to Penang is to fly back to Kuala Lumpur and then fly up to Kota Bharu.
There is a road that goes through here, and the road is dangerous. You don't drive it. So that even within what would be called a peaceful nation-- it's a Muslim country. It's not an Islamic government, but it's a Muslim country.
But it's multicultural. About a third of the population is a third to even more than a third right now is Chinese. And there's a large Indian population, there's indigenous peoples, and then the largest population are the Malays.
And the Malays are the Muslims. That's how they refer to the Malays. And then there's Chinese Malays and Indian Malays. So they actually do distinguish by ethnicity and background.
And so which of the road should we take? We started in Kuala Lumpur, and how we would decide where we'd go often were requests. So Kota Bharu, for example, which is here, had a program and basically didn't know what to do in terms of how to move their support group. They had no idea.
It was a mixed support group of Chinese and Malay, which doesn't always happen, and in the only state within Malaysia that's actually conservative. So that basically everything is in Malay and it's in Arabic. So it's a very different kind of a setting. And the university is here, and their hospital is in Kota Bharu. So even trying to work in terms of how do you kind of work across the two because we do work with many university hospitals.
And then the second place, Kuantan, was-- by the way, Maznah's from Kota Bharu, which also makes a difference. Kuantan is another place that basically we got to because Maznah had a contact who had a contact who had a contact. And the contact got really interested in what we were doing, and she just happened to be the radiologist at the Islamic International University.
They had a support group, but they wanted, again, more help. But they were actually reaching out themselves and really had, actually, a better model than they thought they did, in terms of what they were doing. So that's what I'm talking about. The winding journey. That's really what it was.
And I talk about these road blocks, U-turns. I already talked about the problem of language. Partners. Who do you partner with? We made a big mistake up front. A really big mistake. They were surprised, because I never would have guessed this would have been a mistake.
We had two other partners when we did the translations up front. One was the Malaysian Translation Association, who are wonderful. They had six translators on each booklet because translating into Bahasa the medical terms was very, very difficult, because they're not the same as the English terms.
Not only that, but there was no word in the Malay language for breast cancer. So they had to kind of look around the country and see what different hospitals and different medical centers were calling it and then try to come up with a common word that worked. And they did, but it was a long process, much longer than what we had guessed.
And we had another partner, which was the Australian-- not Australian, sorry. The Malaysian Cancer Association, which was associated with the American Cancer Society, which makes sense, because we were associated with the American Cancer Society for the translations. Unfortunately, and this happened within the first year of the project, on the first translations, they didn't like that there was no pictures in the books. We didn't like that there was no pictures in the books.
But at that point in the project, it would have been a disaster to put pictures of breasts, to put pictures of how to do a breast self-exam. You did not do that. Even when they were teaching for Malay women breast self-exam, they taught it on men. Sounds a little strange, but it's true.
And the audiences were primarily Chinese. When you see the company programs, which were very good, but still, they were primarily Chinese audiences. The other thing is these breast forms that you use, you couldn't have any of those. So that all the kinds of things that would have been really helpful, we just could not culturally do at that point.
Cancer, breast cancer was a taboo. People did not talk about it. People were shunned. The stories that we talked about, and this came from the vice president for operations in Southeast Asia for Boeing Corporation, who we then worked with closely, Boeing Southeast Asia.
His sister-in-law had breast cancer, and she literally was shipped off. No treatment, no anything. Because it was just too shameful-- because his wife was Malay. It was just too shameful for the family. And there's many stories of this nature.
The other thing is what I call discovery learning. We all did a lot of discovery learning along the way. Some of it should have been really obvious. For example, I had a Malaysian post-doc here for three years.
Thank goodness, because he could navigate systems in Malaysia that I couldn't navigate because I didn't know how to navigate. In fact, I'm not sure I could still navigate the systems in Malaysia. Relationships are the foundation, the collection. And how you work is through these relationships.
Phones, cellphones, for example, are critical. Even though you send out emails and formal invitations, it's really you call the brother of someone who plays golf with somebody else who you really want to come, and then-- now, that's not true when you come to the Westerners that you're inviting, but it is true when you deal with the Malay population.
So it's a very, very different kind of sense of how to work and how to develop these partners. But the short-long of that-- a walk away for a couple minutes. But we had to sever the partnership that we had with the Malaysian Cancer Society, which was not easy to do.
But we felt that they were going to take those booklets-- they said they had the copyright, which they did not-- and just take them and do what they wanted with them. And we said absolutely not. You will get-- I mean, that is-- number one, we know.
I've got the legal documents from the American Cancer Society. They have told us exactly what we can do and what we can't do. Ended up that the claims that the director were making were not right. But she was bound and determined to take those and use them. So there was even this piece of jealousy that none of us ever expected to come up.
So again, discovery learning. How do you do that in a Malay way? I mean, you're not really direct in Malaysia. In fact, the more direct you are, the less, probably, you will get something done.
And so I learned very quickly that my directive style, which is something that I think I was born with, was not appropriate. That for the most part, I actually stayed in the background unless they needed a voice from Cornell who-- and Ralph, this is nothing personal-- who was white, in their culture.
Now, I don't think they would have had any problem with Ralph Christy going to Malaysia or any place else he goes. But white had a status. Those of you who have traveled in Southeast Asia will know that there is bulletin boards all over the place to how to whiten your skin. And I don't know what it does to your skin, but it's like-- well, they're such beautiful people.
And it was just interesting because I was very careful when I used that voice. Even though I was the director of the project, I brought in most of the money up front, it was still a voice that I kept kind of silent as I went through.
The cultural differences were absolutely critical to consider. And part of it was just trying to figure out these cultural differences because it was so complex. And also some of it is really hidden, and some of it now is coming to the forefront of being hidden.
Malaysia likes to pride itself on being a multicultural nation. There's no doubt about it. They are a multicultural nation. Underneath that pride is this incredible boiling going on, to the point that the current prime minister is looking at a plan called 1Malaysia, which in essence means putting together a way for these three major cultures to come together in some way, which is going to be really difficult, because the government is primarily Malay.
Your money is primarily Chinese Malay, in Malaysia. And the Indians are kind of split. You have both those who serve as "servants," quote unquote, and those who are in business. It's almost like a split kind of society.
But this is really something that has really started to come. And those of you who have been following the news, in terms of the response to the Christian churches of a ruling in Malaysia that they could use the term Allah in church to mean god, which then sparked riots toward the churches. Not really riots, but sparked destruction. Not total, but more vandalism to the churches.
And that's the first overt act that I can honestly say. But talking with other Malaysians, when I'm not talking with Malays, but when I'm talking with Chinese Malays and Indian Malays, I get a very different story, which is another thing that I had to learn. The religion, the age, the respect for elders.
And what that does in terms of when you're dealing with a disease like breast cancer, that's a taboo, and often it's the mother that the daughter goes to or there's a senior elder in the family. And that senior elder has more control than any information that you can give. So it's working with a whole different population, in terms of age.
And then this notion of save water face, which is literally the idea of never letting your colleague go under water. Never, especially an elder. So you would never disrespect and never in public.
So that Malays have an interesting planning process, which is everything comes at the last minute. I mean, thinking of setting up a program like we set up programs here, especially for this year for the CIIFAD Program is unheard of. I mean, it is literally-- they pull off conferences for 400 people, and the day before you wonder if it's ever going to be pulled off. And this was the first major summit on breast cancer education in Malaysia, and the Queen of Malaysia was actually our sponsor.
And I thought, this may be a disaster. And it wasn't. Everything went off beautifully. And it's taken me a while to learn to trust that it's going to work. And it does work.
Surprises. I've already talked about some of these. One of the real surprises is the continued misinformation about breast cancer. When President Obama was elected-- and since I haven't been in Malaysia since this past summer, I'm going in April because I'm on sabbatical-- there was a different feel toward those of us from the US. We weren't real popular for a while.
That's a nice way to put it. Needless to say, they did not like the Afghanistan war at all, that we had actually entered a sovereign nation. They didn't talk a whole lot about Iraq, but definitely Afghanistan.
But people were more friendly. And I was just having breakfast in the hotel one morning, and a number of people began asking if I would just like to join them for coffee or something. And I thought, this is really different. And there was always at least two people there, because it was a male. I mean, there's always somebody else there.
And one was asking questions about breast cancer. He said, well, isn't breast cancer contagious? And I went, well, no. And as politely as I could, told him no and told him some of the-- we don't really know the causes and went through that kind of thing.
And so this misinformation that still reigns about this. So not only the taboo, but the misinformation. Also the role of the local healer or bomohs within Malay society. And actually, we're hoping to get a study funded where we will actually find out what the bomohs tell women who could have breast cancer. What they recommend or don't recommend related to treatment, what they-- exactly what do they do? What do they believe about cancer?
We have hypothesis. We know from women's stories and physicians' stories and also the data that late presentation is a given in Malaysia, and that's part of the reason for the high death rate. Because actually, the incident rate is very similar to other countries in Asia. Very much so. Which is a much lower incidence rate than in the United States and other Western nations.
But the presenting tumor is usually in stage three. And again, because of lack of information, they often leave treatment. If you've never been through chemotherapy or know someone who has been through chemotherapy, if you don't know what you're getting yourself into, you're probably not going to go back. It's an excruciating experience no matter how-- no matter in the best facility, is not the best thing that can happen to you.
And so basically, if you know where you're going-- and I'm a survivor. I did not have chemotherapy, but I did have radiation. Well, even radiation. I mean, you're sitting there and you're going, what is going on? But I knew what was going on.
So what are the roles of the bomohs? We're not sure. We know that they're spiritual. We know that there's value. And actually, there is a movement now in Malaysia to really incorporate the traditional healers into the actual traditional-- the medicine. The Western medicine system.
Which, in the Chinese medicine and the Indian medicine is working because they have long traditions. And the bomohs would actually like to become a part of that system, but it's not at this point necessarily something that Western physicians favor who are cancer specialists. And there's not that many cancer specialists.
So we're hopefully launching-- if we can find funding-- a study where we will actually talk with bomohs, talk with physicians, talk with patients, so that we can actually have some data to use in terms of how they might be able to work together rather than stories. But we do know of stories, and this includes the highest level of people in society. It's not just people who live in villages. The prime minister's wife, her twin sister, both died of breast cancer within a year and a half time. They both visited bomohs until they had stage three or stage four. Both of them passed away.
And the Ambassador to the United States from Malaysia, the first time I met him-- I had never met an Ambassador before, by the way. So I don't have a clue what I was doing other than the fact that be gracious and those kinds of things. And he would just see me for 15 minutes or a half hour, which was a courtesy visit, which was fine with me.
Well, he began asking questions about why are you in this. And I told him the story. He said, well, you know, my sister-in-law passed away from breast cancer two years ago. And all of a sudden, I go, this is the ambassador to the United States talking with me about his sister-in-law?
It's such a personal thing when this happens. And he was so frustrated because there are four physicians in his family. None of them knew that she had breast cancer. Not one of them. Until, again, it was too late.
And so these kinds of things circulate. The age of cancer patients is much younger, which is really hard to get across to Westerners. Because here, the age is actually going up for the average age for women. In Malaysia, it's still-- median age is like 45, and there's a fairly large percentage in their 40s, which is young. And also more aggressive, because it's premenopausal for the most part. And even in their 30s.
Now, we have some cases here, but there's enough statistical differences in the data that we have, though again, we don't have super data. And then, as I said, incomplete or lack of data on breast cancer, which we still don't have. The government did one study back in 2002, which was all they gave was incidence.
There was nothing about treatment. There was nothing about survival rates. And we have two hospitals that have been tracking, and that's really what we have. Which is really not enough data, because they're very unique hospitals.
And this is just another surprise; me dancing. This is actually a support group, and another surprise for me-- now I'm going to move to some of the good surprises-- is that this is now six years into the project. Our program started in this tiny little office. Literally.
And we worked out in the community, which is where we should be anyway. But what was interesting is that we were looking for a home. Because without a home, a permanent home, the program would never become sustainable.
Somehow, I have no idea how, through a simple meeting with the Vice President for International Relations at the University, he said, oh, by the way, I think perhaps the medical school has room for you. We went, oh, OK. So he calls the dean while we're sitting in the office, and sure enough, they had room for us.
We now have a humongous cancer resource center. And this part of it, which is really interesting, is there's mirrors on the side. Because part of what they do is exercises. So they've incorporated that.
But part of the differences is that-- I mean, there's the typical resource room. They've gone to an online system. They're the first online system in Malaysia for cancer information. And they're moving toward more general cancer information, not just breast cancer. There's also a cancer answer line that is staffed by a nurse.
But there's also a room that's for quiet, and that's for two purposes. One is a prayer room. Because with Malays, basically, prayer four times a day is a given. Whereas not all the people in the support group are Malays, but the majority are.
But it's also for people who are in the support group who are going through treatment. And they may just be tired. They don't want-- the meetings usually last-- oh, they usually start about 9:00 or 9:30, and they go through lunch. And people just bring food for lunch. But they're a great group of people.
Interestingly enough too, you'll notice the color purple. They chose not to use pink. It was too westernized. They went with purple, which was an interesting kind of-- and building relationships. This was my first surprise every time I walked in last summer, was this resource center, to be honest. Because it was so modern and so well put together and so well thought out.
My second surprise was that we had the launching of that center and the new online information system that summer also. And they had a huge auditorium, and I said, where are we going to get 600 people or 700 people for this auditorium? Guys, we've never had more than 400.
And Maznah and Asmin had been in Mecca, they had traveled to Mecca with her brother, which they needed to do. And basically, they came back and had two weeks to put it together. There was 900 people there from across Malaysia. This is what's happened to the project.
And so these surprises also-- and there are many different kinds of people. You'll notice a lot of headscarves, but you also notice women without headscarves. That will tell you a lot about race and also about religion.
You'll also see though, they're predominantly folks for the other side, but there are some in that picture that have nurse's caps. On the other side, there's a whole bunch of them, on the other side of the auditorium. And it ends up there were 900 people. We had to go into an overflow.
They were interested in the resource center, because no one had one of this nature in Malaysia. And basically, one of the things that was difficult is because we had the Minister of Women and Community Development was our major speaker, and she has really backed up this-- our whole effort. With money from her ministry, with a whole bunch of things, and she's a superb speaker.
And at this particular one, what was especially interesting, is you always write the speeches for people coming in. I mean, that's a given. Well, she didn't stick to her script at all. She spoke from her heart. And again, she also has a relative, a cousin, who, again, she found out totally by accident that she had breast cancer. It was not well known in her family at all. And she actually shared this in public, which is almost unheard of.
So tangible results. I've already mentioned many of them. And we're in the process now of beginning to do what we call a retrospective research study, which means we're taking a look at-- we honestly think we have a successful program, and we've got a lot of data, and we have yearly reports. We have numbers of people. I mean, we're even offering now programs in mosques for women. Educational programs on breast cancer.
The resource center not only has breast forms, which is a huge step forward-- I know it doesn't sound like much, but it's huge in a country where that was just seen as something you did not do-- to low literacy materials that also have pictures. And they're very useful pictures. What we were finding is physicians would take these gross pictures of these gross cancers and show them to their patients and say, if you don't get treatment, this is what's going to happen to you.
And one of those physicians happened to be the ambassador to the United States' brother. And I said, oh good. I'm having dinner with him. And I called Gonzali and I said, do you have any ideas what I'm supposed to do? And he said, be nice to him, but tell him. Oh, this is going to be an interesting challenge, to be nice to him and tell him that those are really not very helpful to show your patients.
So we went, and now we have low-literacy. We've also begin translating into Chinese. Into Mandarin. So that's our next piece of translation. And this puts these hands on the wall. These are hands, and anybody that comes into the center will sign the hand. And it's a greeting to someone who is either experiencing or a survivor of breast cancer, a family member, so that messages can be left that other people can share.
Again, this is a relational society. This is different than what we live in in the United States, which tends to be highly individualistic. So it calls for different ways of thinking and local customs, religion, everything that I've mentioned have come up.
So what we've come to-- and this is a hypothesis at this point-- is we've come to trying to kind of conceptualize what a sustainable program internationally might be. And this is somewhat different than what you usually see in your literature related to sustainability. I realize that. But sustainability is actually the center. Whoops, didn't mean to do that. Let me go back.
Sustainability is actually the center. But there are also components; people, capacity building, funding, time, power, realistic goals, which all come into play. And the more that I'm reading lately, because I'm doing a third edition of a program planning book, the more I'm reading about this, about this, this is a word that's been around for quite a while, not that we necessarily do it, but it's something that we're supposed to be doing, just like sustainability is something.
And this is something that often is not mentioned, and actually, one I took a look at. The most underutilized elements of this, one is people. This is actually our staff now in Malaysia. When we started, there was the three of us, right there.
And this is now-- the support staff, that includes students as well tech people, et cetera. Time. What can I say? It takes time. A major change, like cancer, which is a taboo, is not a quick, in-and-out, two-year. You're not going to make very much change.
And especially, this is a middle-income country. Parts of it are low income. So when you're into that kind of an economic condition-- and they have many more facilities than most developing nations, very definitely. And then I mentioned realistic goals. Notice how these are going out like this and this and this and this and this. Is actually getting on the ground goals that work, so you can demonstrate to people that they work.
The booklets were a demonstration. Because they're now used all over Malaysia. They're the only translations in Bahasa, and now we've moved into low literacy. And it's not that we care about that we want to be the project. Actually, we don't want to be. We want to be a coordinating support center.
But the idea that we had one central goal upfront that was tangible, as well as this other grand goal. And then-- whoops, I keep going. Factors affecting working models of sustainability. Knowledge and the technical process and local.
Cultural, we've been through that. All of the stakeholders that we hear lots about, and the wider environment, which we also hear lots about. This is the part, I think, that is the most complex. And this is from an educator of social sciences standpoint.
That knowledge, what is considered knowledge? What do you consider knowledge? Is it something that you test? Is it something that you can see a behavior change? Is it something that changes in a test tube? Or is it local knowledge, which can't be quite explained the same way, to say the least.
The knowledge of the people with which you are working. So that you have a sense of where they are coming from, where their strengths are, and where you, as someone as the outsider, can either work well with them or literally turn them off.
One of the seminars last year was very, very impactful when the person who was working in Afghanistan, conflict situation, said he never goes in with a guard. He doesn't want a gun. Because he knows who he needs to talk to. he needs to talk to the elders, and he needs to talk to those who are going to be against him. He says, and no gun is going to protect me in the world.
And I thought, whew, number one, he's brave, and number two, just the whole idea of having this sense of moving into a village, which is not the easiest things to do. Who defines that knowledge, and who chooses what knowledge to use? Outsiders, insiders, or a group of people together, insiders and outsiders. Which I think is really important in terms of who actually chooses which knowledge. Absolutely.
We call it our Heart Project. These are some additional people that got involved. All of them have been touched by cancer in one way or another, which is not unusual in these kinds of projects. And then just a final thought.
Those of you who have read Tea for Three, Greg Morrison. He has a new book out, Stones Into Schools. And obviously, it's made a huge impact, at least a lot of people have read it.
And what I liked about this quote is kind of how he took a look at what his role was and how this was not something he learned sitting in graduate school. This was something he learned by doing. I mean, I don't even know what degrees he has, to be honest. I'm not even sure he's ever said what degrees he has.
But Greg has listened carefully, built relationships with village leaders based on trust and respect, and involved people in shaping their own future. He has taken the time to learn the local culture; courtesy, hospitality, respect for elders, and understand and appreciate the role that Islam plays in people's daily lives. He's working in an Islamic country. So I'll stop there and say thank you.
RALPH CHRISTY: Professor, thank you for that wonderful journey you just brought us through. We have about 5 to 10 minutes, and maybe there are some questions from the audience.
ROSEMARY CAFFARELLA: Please. Could you just identify yourself? That would be helpful.
[? ROY KOLIG: I'm ?] Roy [? Kolig. ?] This might be a naive question. So I'll--
ROSEMARY CAFFARELLA: Oh, no, no, no. Nothing's a naive question as far as I'm concerned.
[? ROY KOLIG: Would ?] it have been useful to start with other kinds of cancer first and then move to breast cancer?
ROSEMARY CAFFARELLA: That's a very good question, because I honestly don't have an answer. It's not a naive question at all. I think it was-- I mean, as I said, it was kind of an accident that we were even in Malaysia doing this project. Though I'm inclined to work internationally, I had not thought of doing it in this way.
And whether we had started with another cancer-- because you never, for example, hear them talk about cervical cancer. Those are two of the women's cancers, and they're actually the biggest killers. I've never heard the word prostate cancer even talked-- I mean, I've never seen the term prostate cancer in writing or anything that I'm aware of.
And so whether or not-- and those are all-- but whether you had started with something like lung cancer, though again, among Malays, since supposedly they don't smoke-- sorry, but I have to use a supposedly because some do-- I just don't know. I do know one thing about breast cancer that I can tell you for sure is it touches. It really touches those who are cancer survivors, who are family members of those who are survivors who have passed away. And there is this bond.
One reason why I can walk into support groups there, there is a bonding between myself and those women because I'm a cancer survivor. And part of it is I have to stay in my survivorship role of offering support, because oftentimes, they'll ask me medical questions, which I can't answer. So I have no idea. Good question. Ralph.
RALPH CHRISTY: You started at the outset of your presentation to talk about the need to learn culture, to be aware of culture. And throughout the presentation-- and you ended on this cultural kick. What might you offer in the way of suggestions to graduate students who come to Cornell to study development and oftentimes are thrust in the world, where they have to learn science and technology theory without a real systematic to focus on culture. What might you offer to them in way of suggestions to become more culturally aware?
ROSEMARY CAFFARELLA: Jenelle, you and I could talk about this. [LAUGHS] Jenelle is doing some work related to graduate programs that actually incorporate experience in different countries, with one of the focuses being cultural kinds of competencies. And I don't even call them competencies. I would say, I'm thinking here of John Forester, who's a professor on this campus, very good, and a number of others.
And this I think you can do in your own classes, you can do with the professors that you have. Because often, the classes here are mixed. At least when I teach international development, and if you're in those fields, they're mixed-- they're from all over campus, but they're also international. And listening, observing, and using the experiences and listening to those experiences of the students is extraordinarily enlightening, not just to myself as a professor, but to other students.
And this is feedback that I get from students in my classes. Because we-- one of the objectives that I set for class is to build a learning community, which means hopefully-- it doesn't always work-- but hopefully, an open community where they feel like they can disagree, where they feel safe for whatever they might say. Because some of them are pretty hard questions that we're answering.
So it's this whole listening and being receptive to that. And for example, there were two students that I had in my class last spring. Actually, three. One was an American, one was from Africa, and the third, who was from Nepal.
And all of them had gone on the India project, through Cornell, of course, here. And one was no longer-- not here, but he was doing his thesis, but he was down in Ecuador. But the other two couldn't wait to show me their slides and tell me what they had learned.
And so the idea is to join, I would think, with others who-- if you're thinking about doing international development or have been involved in it, is find people who have had this kind of experience and listen to what they have to say and kind of watch and ask them about cultures and symbols and ask them like, in my classes, I'll bring speakers in who are students. I'll bring masters and doctoral students in that I've had in class that could actually relate what it's like to be a US-- to be a student in the US, number one, with language.
But even more than that, the sacrifices that most of them make when they come here. I mean, they're absolutely incredible sacrifices to get an education at Cornell. And yet, they're willing to do it, and their stories are just incredible. So that's-- but I'm a storyteller, as you can tell. [LAUGHS]
RALPH CHRISTY: We are just about out of time. Please join me again in thanking Professor Caffarella.
ROSEMARY CAFFARELLA: Thank you.
RALPH CHRISTY: I would invite you all again next Wednesday to hear Professor Larry Walker on biofuels and the intersections in food and fuel and energy. Thank you all very much.
ROSEMARY CAFFARELLA: Thank you.
[SIDE CONVERSATIONS]

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Breast cancer is the most common and deadliest form of cancer among Malaysian women, yet breast cancer literature in Malay languages did not exist--largely because of cultural mores about women's bodies, and a lack of education and diagnostic tools.

Cornell professor and longtime breast cancer survivor Rosemary Caffarella describes her seven-year effort to develop a breast cancer education program in Malaysia. Caffarella is a professor of adult and extension education at Cornell.